=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366506891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEAN LEUNG CHEN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 05/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 49TH ST LUTHERAN FHC SUNSET TERRACE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-437-5239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 3RD AVE MANAGED CARE DEPARTMENT
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-3702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-630-7477
-----------------------------------------------------
Fax | 718-630-7437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 068570
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 077605
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------